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. 2019 May 10;14(5):e0216112. doi: 10.1371/journal.pone.0216112

Table 6. Study characteristics, findings reported and the risk of bias assessments for studies that report on process outcomes (n = 28).

Study Country Study Design Sample Disease Category Type of
Community Involvement 		Type of Outcome Relevant Findings Risk of bias
s p d a r Overall
Gloppen et al 2012 [18] United States RCT 12 pairs of matched communities in 7 states Community Health Communities That Care (CTC) coalitions—mobilize stakeholders to implement prevention programs to promote adolescent health and wellbeing. Process Outcome 20 months after study support ended which included tailored training, technical assistance, and funding: 1) 11 of the 12 CTC coalitions still existed. 2) CTC coalitions maintained a relatively high level of implementation fidelity to the CTC system. Medium
Boivin et al
2014 [19] 		Canada RCT 172 individuals from 6 communities Non Communicable Disease Communities involved to set priorities for improving chronic disease management in primary care. Process Outcome 1) Priorities established with patients were more aligned with components of the Medical Home and Chronic Care Model (p < 0.01). 2) Priorities established by professionals alone placed more emphasis on technical quality of disease management. 3) 41% increase in agreement on common priorities (95%CI: +12% to +58%, p < 0.01). 4) Patient involvement increased the costs of the prioritization process by 17%, and required 10% more time to reach consensus on common priorities. Low
Study Country Study Design Sample Disease Category Type of
Community Involvement 		Type of Outcome Relevant Findings Risk of bias
s p d a r Overall
Sansiritaweesook et al 2015 [16] Thailand Intervention study 182 informants, 562 surveillance networks, 21,234 villagers Environmental Health 7-step process used to develop a model for local drowning surveillance system based on community participation. Process Outcome 1) Villagers collaborated to conduct a situation analysis, design, and trial a prototype intervention, scale up to a full system design and trial that was followed by system improvement and dissemination. 2) 80% of networks were cooperative in submitting timely reports and using them for action. 3) Accuracy of information in reports increased from 65% to 90%. Medium
Hoelscher et al 2010 [20] United States Intervention study 15 schools receive BPC intervention, matched with 15 schools that receive BP only Healthy Living School-based obesity prevention program (CATCH BP) versus complimentary program (CATCH BPC) that formed partnerships with external community organizations. Process Outcome 1) BPC schools demonstrated better outcomes with more activities and lessons than BP schools. 2) In year 2 there was a higher mean number of physical activity and healthy eating programs being implemented in BPC schools (mean = 3.71 programs) compared to BP schools (mean = 2.73 programs). Unclear
Neto et al 2003 [21] Brazil Intervention Study 1,524 households in intervention area; 1,564 households in control area Infectious Disease A preliminary diagnosis presented to the community to launch a discussion aimed at defining future actions, implementation of the actions in the study area with community participation. Process Outcome Changes in the study area included: vector control workers began demonstrating preventive measures without removing potential breeding places or using larvicide; use of educational aids specific to the local reality; activities related to the residents’ priorities; and activities such as music, theater skits, scavenger hunts, and games to demonstrate the vector cycle. Unclear
Clark et al
2014 [22] 		United States Intervention study 1,477 parents of children with asthma in coalition target areas and comparison areas Non Communicable Disease Allies Against Asthma program—a 5-year collaborative effort by 7 community coalitions designed to change policies regarding asthma management in low-income communities of color. Process Outcome 89 inter- and intra-institutional changes were made on systems and policies to statewide legislation across the 7 communities. Unclear
Study Country Study Design Sample Disease Category Type of
Community Involvement 		Type of Outcome Relevant Findings Risk of bias
s d n c Overall
Nathan et al
2006 [23] 		Australia Cohort 47 staff in 2001; 43 in 2002 Community Health Community Representatives Program—community members provided the opportunity to give input on service delivery issues and needs in the community and to be active participants in committee work of the health service through participation in decision-making committees with other stakeholders. Process Outcome 1) Significantly more staff at the follow-up survey reported that they and other staff were clear about the role of community representatives and how to work with them on committees. 2) Significantly more staff at follow-up felt that the health service was ready for this type of initiative. Unclear
Akiyama et al 2013 [24] Thailand Cohort 43 primary-level schools Community Health Health Promoting School program with the aim of encouraging schools to improve school health. Interventions include 6 one-day training workshops and an action plan support involving teachers. Process Outcome 1) Increase in school and community partnership [mean score 1.0 pre (median = 1.0, IQR = 0.5–1.5) vs. 2.4 post (median = 2.5, IQR = 2.0–3.0)]. 2) Improvements in the definition of the roles and responsibilities with the Burmese community [mean score 0.4 pre (median = 0, IQR = 0) vs. 2.7 post (median = 3.0, IQR = 3.0–3.0)]. Medium
Reeve et al
2015 [25] 		Australia Cohort N/A Non Communicable Diseases A health service partnership between an Aboriginal community-controlled health service, a hospital, and a community health service that implemented an integration of health promotion, health assessments, and chronic disease management. Process Outcome Short-term outcomes– 1) Increase in occasions of service (from 21,218 to 33,753) particularly in PHC in remote areas (from 863 to 11,338). 2) Increased uptake of health assessment (from 13% of eligible population to 61%, then to 73% of those identifies with DM placed on a care plan). Medium-term outcomes– 1) Over a 6 year period, improvements in quality-of-care indicators, i.e. glycated hemoglobin checks and proportion of people with DM receiving anti hypertensives. 2) Increase in proportion of patients identified with chronic disease or risk factors. 3) Increased PHC episodes and follow-up. Medium
Nelson et al
2006 [26] 		Canada Cohort 79 Consumer
Survivor Initiative members		 Non Communicable Diseases Consumer Survivor Initiatives—organizations that are operated by and for people with a history of mental illness. Process Outcome Members participated most often in internal activities (e.g. social-recreational, committees) and least often in external activities (e.g. advocacy, planning, education) with an average of 3 activities per month. Low
Litt et al
2013 [27] 		United States Cross-sectional 59 collaborative groups representing 22 states Healthy Living Collaboratives formed to improve the built environment and policies for active living. Process Outcome Groups made progress in identifying areas for environmental improvements and in many instances received funding to support these changes: 1) Groups’ environmental improvement scores ranged from 1.5 to 5.0, with an average of 3.5 (SD: 0.9). This average indicated that groups typically had funding to support their initiatives and had started but had not completed the planned improvements. 2) Groups’ policy change scores ranged from 1.0 to 4.5 with an average of 2.9 (SD: 1.0), suggesting that groups had generally identified a policy gap and had started discussions to develop new policies or changes to existing policy. High
Study Country Study Design Sample Disease Category Type of
Community Involvement 		Type of Outcome Relevant Findings Risk of bias
1 2 3 4 5 6 7 8 9 Overall
Gibbons et al 2016 [28] United States Qualitative 3 focus groups, 8 in-depth interviews, 31 individuals surveyed Community Health Community-academic collaboration using CBPR known as the 'Community Health Initiative: Creating a Healthier East Baltimore Together.' Process Outcome 1) Enabled the development of authentic community-academic relationships. 2) Enabled establishment of a “level playing field” among residents. 3) Enabled change in attitudes, perceptions among personnel and residents of each other. 4) Enabled residents to become active participants of the decision-making process. N Y Y Y Y N Y N N N Medium (5/10)
Trettin et al
2000 [29] 		United States Qualitative 6 to 14 participants of 3 focus groups (total n = 60) Community Health Volunteer-based community health advisory program developed to increase residents' access to health services, stimulate their interest in health, disease prevention, and awareness of health-related environmental issues, and empower residents to be more involved in community health. Process Outcome 1) Planning approach for the program identified as appropriate for local context. 2) Existing list of problems and needs identified as accurate with perspectives of local participants. 3) Field-workers established good relationships with the community. N Y Y Y Y Y Y N N Y Medium (7/10)
Carlisle et al
2010 [30] 		United Kingdom Qualitative Not mentioned. Semi-structured interviews Community Health 'Social Inclusion Partnerships'—organized around committee-style management board meetings attended by members from statutory, voluntary, and community sectors. Process Outcome Drug and alcohol misuse classified as a particular problem amongst younger people. Y N Y N Y N N N N N High (3/10)
Johnson et al 2006 [31] United States Qualitative 40 community based organizations (CBOs) selected for interview Community Health CBOs involved in implementing health-related projects through locally administered micro-grants. 'The Healthy Carolinians Community' serving as grantors partnering with the CBOs Process Outcome Microfinancing CBOs aided in: 1) Building partnerships and connections within and outside their communities. 2) Gained new ideas and knowledge. 3) Developed local leadership and expertise. 4) Increased their ability to focus on and progress towards goals. N Y Y Y Y Y Y N N Y Medium (7/10)
Ferrera et al 2014 [15] United States Qualitative 23 youths interviewed Community Health CBPR used to form a Youth advisory board. Youth involved in decision making and programming, as well as in a feedback and improvement role. Process Outcome 1) Students feel consistently comfortable with program staff and the sense that a personal and emotional investment was made. 2) Program participants went on to give health education to approximately 800 community members. 3) 500 community members attended the health fair hosted by a participating school. Y Y Y Y Y N N N N Y Medium (6/10)
Heaton et al 2014 [32] United States Qualitative Interviews, focus groups Community Health Collaborative partnership between 2 academic health centers and CBOs to determine topics, and develop a bi-directional educational seminar series called 'Community Grand Rounds' (CGR). Process Outcome 1) Partnership had good adherence to principles of collaborative and equitable group process in planning of the CGR event. 2) Educational seminars facilitated bi-directional communication between their community and university medical center. 3) Format and content of seminars effectively tailored to unique needs of each community. N Y Y Y Y Y Y Y N Y Low (8/10)
Litt et al 2013 [33] United States Qualitative 59 participants from collaboratives interviewed Healthy Living Multi-sectoral collaborative groups promote active lifestyles through environmental and policy changes. Process Outcomes 1) Groups reported working on an average of 5 strategy areas including parks and recreation (86%), Safe Routes to School (85%), street improvements (78%) and streetscaping (69%). 2) More than half of groups reported their environmental initiatives as either in progress or completed. 3) Groups reported the most success in changing policy for public plazas, street improvements, streetscaping, and parks, open space, and recreation. N Y N N N N N N N N High (1/10)
Rutter et al 2004 [34] United Kingdom Qualitative 32 interviews conducted in one trust and 17 interviews in another trust of service users and sector reps Non Communicable Diseases User or patient involvement in the planning and delivery of health services through meetings between service managers and users; development of documents by user groups; service provider (Trust) meetings involving user representation. Process Outcomes Positive outcomes of user involvement reflected in their participation in campaigns against Trust plans; in refurbishing of inpatient units; in contract specification and monitoring of hotel services; in policy, practice and information about women's safety; and in integration of health and social services. N Y Y Y Y N Y N N N Medium (5/10)
Chervin et al 2005 [35] United States Qualitative 364 in-person interviews with project staff, evaluators, and community and agency members Infectious Diseases Center for Disease Control and Prevention’s Community Coalition Partnership Program–building a community’s capacity to prevent teen pregnancy through strengthening of partnerships, mobilization of community resources, and changes in the number and quality of community programs. Process Outcome 1) Partners worked together to reduce duplication and fill gaps in services through collaboration and differentiation of activities. 2) Development of new programs from the partnership. It was noted however that increased partner skill, program improvements, and new programs did not appear sufficient to affect community capacity. N Y Y Y Y Y Y N N N Medium (6/10)
Study Country Study Design Sample Disease Category Type of
Community Involvement 		Type of Outcome Relevant Findings Risk of Bias
von dem Knesebeck et al 2002 [36] Germany Case Study Not mentioned Community Health A community-level health policy intervention: 'Local Co-ordination of Health and Social Care' project. Process Outcome 1) 70% agreement between managers of Project Offices, moderators and other key actors on usefulness of 'Round Table' to improve coordination of health and social care at the community level. 2) Success in the development and enactment of recommendations for action programs e.g. improved information dissemination, further development of geriatric ambulatory rehabilitation. 3) Development of health monitoring and reporting activities at the community level. 4) Improved cooperation among participating communities through increased transparency. N/A
Keene Woods et al 2014 [37] United States Case Study Not mentioned Community Health Community Change Intervention that focused on building coalition capacity to support implementation of community changes for program, policy, and practice. Process Outcome 1) Coalition facilitated an average of at least 3 times as many community changes (i.e., program, policy, and practice changes) per month following the intervention. 2) After intervention, there was increased implementation of 3 key prioritized coalition processes: Documenting progress/using feedback (75% increase in stakeholders involved in designing the documentation system); making outcomes matter (50 to 100% increase in activities relating to incentives, accountability, and use of longer term outcomes with accountability); and sustaining the work (42% to 75% increase in identification of sustainability decision makers, determining what to sustain and duration of sustained effort). 2) A 1-year probe following the study showed that majority of the community changes were sustained. N/A
Bursztyn et al 2008 [38] Brazil Case Study Not mentioned Community Health A project was developed and implemented in primary health centers to improve young men’s adherence to a teenage health care program using participatory planning techniques, and rapid assessment procedures. Process Outcome 1) Self-assessment workshops were held with the local teams. Despite good awareness among the health professionals, the project’s results varied between health centers. Over-centralization and lack of flexibility appear to be related to lower capacity to incorporate new practices. 2) Health centers where specific strategies were observed showed more successful results. N/A
Orozco-Núñez et al 2009 [39] Mexico Case Study Not mentioned Community Health Use of participative strategies and the creation of support networks for poor pregnant women. Process Outcome Coordination and community participation were relevant in relation to major resources allocation and availability, particularly housing and transportation. N/A
Baker et al
2012 [40] 		United States Case Study Not mentioned Healthy Living 'Active Living by Design' partnerships were established to change environments and policies, and support complementary programs and promotions to increase physical activity. Process Outcome The connections among diverse community partners created a foundation that enhanced lead agency efforts to form, implement, and maintain policy changes and physical projects, as well as promotional and programmatic approaches, to support active living. N/A
Rapport et al 2008 [41] United Kingdom Case Study Focus groups with project steering group Healthy Living Action research project–organized to respond to a context of funding and service delivery, helmed by a Project Steering Group made up of community members, study organizers, statutory board members. Process Outcome 1) Community members involved acquired new skills and "strengthened individual competencies," heightened knowledge amongst the community and Project Steering Group of community members' needs and desires," influenced working practices, altered perspectives and raised awareness of issues surrounding trust and communication within partnerships. 2) The data generated by the community interviews was perceived as more robust evidence that could be "taken seriously and gave credibility to the communities' comments and requests." N/A
Diaz et al 2009 [42] Cuba Case Study Not mentioned Infectious Diseases Ecohealth approach used as a strategy to ensure active participation by the community, diverse sectors, and government. The approach allowed holistic problem analysis, priority setting, and administration of solutions. Process Outcome 1) The strategy had been sustained two years after concluding the process. 2) 93.5% had attended trainings under the project and 89% knew that the inhabitants of the neighborhood had organized themselves into groups promoted by the project. 3) 93.5% considered that the community improved its ability to identify problems that affected its ecosystem and proposed solutions. N/A
Barnes et al
2006 [43] 		United Kingdom Case Study Not mentioned Non Communicable Diseases Users of a community mental health inter-professional training program (partnerships with service users) involved in the commissioning, management, delivery, participation, and evaluation of the program, as trainers and as course members. Process Outcome Commitment to partnership established, reinforced by service users participating in the commissioning of the program and its evaluation, e.g. service users took active part in the steering group that advised research. N/A